Commentary: ER doctor: Next COVID-19 fight is to flatten the bureaucracy

By Carrie Mendoza

Chicago Tribune|

Apr 06, 2020 | 5:34 PM

Dr. Carrie Mendoza and her husband, Myles, play with their family dogs Shamus and Rocky after she arrived home from work on April 3, 2020, in Glencoe. Mendoza is a Chicago-area emergency physician and is treating patients with COVID-19. (John J. Kim / Chicago Tribune)

For most people, the sacrifice is clear — stay at home. By practicing social distancing to slow the spread of the novel coronavirus, each resident of Illinois and other states under stay-at-home orders is doing a service to society, even if it feels like you’re just sitting on your couch.

The sacrifice from our medical community, however, requires the exact opposite. We are being asked to run toward the problem, toward personal risk and toward a deadly enemy. When duty calls, we who are emergency medical professionals show up, work hard and save lives. We work in emergency departments that are overwhelmed and running out of space, where the luxury of even a moment of silence to process the emotional toll of what we are experiencing doesn’t exist.

Then after these long, exhausting shifts, our health care teams go home too.

I come home to my sequestered and working-from-home husband, Myles, who now juggles overseeing remote learning with our three teenage boys, while still leading a statewide nonprofit.

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This daily routine would be far less stressful if we knew that all physicians had the tools and equipment needed to fight this invisible killer. Unfortunately, that is not always the case. I have been fortunate to have the personal protective equipment needed after some confusion and shortages, but other clinicians around the country are still struggling to stay safe.

Dr. Carrie Mendoza arrives home from work April 3, 2020, carrying a bag containing the street clothes she wore while treating patients with COVID-19. Mendoza is a Chicago-area emergency physician. (John J. Kim / Chicago Tribune)

Dr. Carrie Mendoza places the street clothes she wore to work into the washing machine after arriving home April 3, 2020, in Glencoe. (John J. Kim / Chicago Tribune)

In the last few weeks, I have treated dozens of patients with COVID-19. Unlike your average day in the emergency department, I’m now paranoid of my every move, worried not only of contracting the virus, but of bringing it home. I live with the invisible potential that follows me — coronavirus on my shoe, or on my hair, under my nail. Just a few weeks ago, these thoughts would’ve seemed crazy.

I come home, race to put my clothes in the washing machine and rush to the shower, feeling the panic of Karen Silkwood and worrying about being contaminated myself — and being concerned for our family’s safety. We live with the invisible risks. We avoid hugs, even when the kids need them most. We keep space when they need reassurance and love.

So, what needs to happen to ensure we are never caught off guard like this again? It’s simple: Flatten the bureaucracy. The term “flatten the curve” has become the new national mantra on containing the spread of coronavirus. On the health care front lines, it would make sense to flatten the bureaucracy. Modern health care has developed into a giant bureaucracy filled with nonclinical people often out of touch with clinicians and patients.

Those on the front lines know the bureaucracy of medicine has gotten in the way of the sacred doctor-patient relationship. During this crisis, managers and algorithms can’t save people. Medical professionals can. Commonsense operational changes physicians have wanted for years are finally being implemented.

Dr. Carrie Mendoza leans in for a rare hug with her son Max, 12, after arriving home from work and taking a shower on April 3, 2020, in Glencoe. Mendoza is a Chicago-area emergency physician and is treating patients with COVID-19. (John J. Kim / Chicago Tribune)

Due to the crisis, the government has suspended hospital reporting requirements that have little to do with emergency care, allowed licensed physicians to practice across state lines, expanded telemedicine and provided commonsense malpractice relief. But it shouldn’t take a crisis to reduce bureaucracy in health care.

We should apply this same mantra to manufacturing, so we aren’t caught without critical supplies in the future.

America has outsourced its manufacturing capacity, purchasing from other countries the things we rely on for basic survival. Does that make long-term sense for our health care system, economy or national security? This COVID-19 pandemic answers that question without ambiguity. No. We need to reestablish advanced manufacturing at home and secure our supply chain for critical needs.

That means partnering education with the trades. Our craftsmen, supply chain operators and manufacturers can bring their expertise in training upstream to high school students and prepare them for stable careers. Illinois, let’s learn the lessons this crisis is trying to teach us.

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Some of my patients are business owners and manufacturers, while some work in the factories to assemble goods. They all have the same fear in their eyes worrying about how sick they may become. Supply chain preparedness and health care safety are shared common goals along the entire socioeconomic spectrum.